新辅助化疗对肌层浸润性膀胱癌死亡预后风险的荟萃分析

Effects of neoadjuvant chemotherapy on the prognostic mortality risk of invasive transitional bladder cancer： a meta-analysis

目的探讨新辅助化疗对浸润性膀胱癌预后风险分析。方法以网上检索Pubmed、Medline、Embase、Cochrane等数据库，同时手工检索相关会议论文集、学位论文汇编等，检索年限从建库至2012年9月，获得新辅助化疗对浸润性膀胱癌的前瞻性随机对照试验，提取纳入文献中5年生存率进行荟萃分析。结果最终有14项前瞻性随机对照试验纳入本研究中，发表时间为1991至2012年，其中新辅助化疗组2072例，对照组2086例。总体分析显示接受新辅助化疗的患者的总体死亡风险比对照组降低了21％（OR=0．79，95％CI：0．70～0．90）。根据不同新辅助化疗方案而进行的亚组分析，其中MCV方案（甲氨蝶呤＋顺铂＋长春花碱）化疗组的死亡风险比对照组降低了28％（OR：0．72，95％CI：0．60～0．86），MVAC方案（甲氨蝶呤＋长春花碱＋阿霉素＋顺铂）化疗组的死亡风险比对照组降低了25％（OR=0．75，95％CI：0．59～0．96），而C方案（顺铂）化疗组、CM方案（顺铂＋甲氨蝶呤）化疗组、CD方案（顺铂＋阿霉素）化疗组与各自对照组相比，死亡风险的差异无统计学意义；根据新辅助化疗后。患者接受的不同局部治疗而进行亚组分析，接受根治性手术组的死亡风险比对照组降低了25％（OR=0．75，95％CI：0．65～0．87），而接受放疗组或根治性手术联合放疗组的患者，与各自对照组相比死亡风险的差异无统计学意义。结论MCV方案和MVAC方案的新辅助化疗能改善浸润性膀胱癌的预后，新辅助化疗后，接受根治性手术患者，其预后也获得明显改善。

Objective To systematically assess the effects of neoadjuvant chemotherapy on the prognostic risk of invasive transitional bladder cancer. Methods All known randomized controlled trials （RCTs） on neoadjuvant chemotherapy in the treatment of invasive transitional bladder cancer, published from the date of database building to September 2012, were retrieved from such databanks as Pubmed, CBMdisc, Embase and Cochrane. The data on 5-year survival rate of included studies were extracted for further heterogeneity exploration, subgroup analysis and statistical pooling with the RevMan 5.10 software. Results Fourteen subjects involving 2072 cases and 2086 controls were published from 199l to 2012. The overall odds ratio of survival suggested a 21% relative reduction in mortality risk for neoadjuvant chemotherapy compared to that on control （ OR = 0. 79, 95% CI： 0. 70 - 0. 90 ） . In subgroup analysis according to different neoadjuvant chemotherapies, MCV （methotrexate, cisplatin and vinblastine） and MVAC （methotrexate, vinblastine, adriamycin and cisplatin） chemotherapies showed significant benefit to overall survival with 28% and 25% reduction in risk of death respectively （OR = 0. 72,95% CI： 0. 60 - 0. 86, OR =0. 75,95% CI：0. 59 -0. 96）. However, no significant difference existed in effects between C （eisplatin） chemotherapy, CM （cisplafin and methotrexate ） chemotherapy and CD （cisplatin and doeetaxel） chemotherapy and controls. In subgroup analysis acc, ording to local treatment of eystectomy or radiotherapy after neoadjuvant chemotherapy, the patients with eysteetomy showed significant benefits in overall survival with 25% reduction in risk of death （ OR = 0. 75,95% CI： 0. 65 - 0. 87 ） . However, the patients with radiotherapy or radiotherapy plus eysteetomy showed no significant benefits in overall survival. Conclusions MCV and MVAC neoadjuvant chemotherapies improve survival among patients with bladder cancm： And neoadjuvant chemotherapy has better long-term survival after cysteetomy.